ALPP CLC Exam 2026 Certified Lactation Counselor REAL/Authentic Proctored Exam Complete 3 Versions Exam Each 100 Questions Graded A+ (300 QUESTIONS) | 100% Accuracy.

ALPP CLC Exam 2026 Certified Lactation Counselor REAL/Authentic Proctored Exam Complete 3 Versions Exam Each 100 Questions Graded A+ (300 QUESTIONS) | 100% Accuracy. Breastfeeding trends - ANS--last 150 years or som rates have declined Breastmilk composition - ANS--human milk changes continually, makes it impossible to obtain a single representative sample of milk Breastmilk composition changes - ANS--- over the course of lactation - within the day - within a feeding - between feedings Is also changes by the way it is taken By two weeks at the latest: - ANS--the baby should regained to its birth weight Breastfeeding protection - ANS--focuses on government, manufacturer, and social responsibility to assure breastfeeding's ability to compete with commercial interests; includes addressing improper marketing practices; the AAP advices not to provide formula, company gift bags, and industry-authored handouts; in the US, state and local breastfeeding legislation addresses breastfeeding in public, employment issues, jury duty, family law, mothers in prison, etc. AAP weight loss stance in 2005 - ANS--"weight loss in the infant of greater than 7% from birth weight indicates possible breastfeeding problems and requires more intensive evaluation of breastfeeding and possible intervention to correct problems and improve milk production and transfer" AAP weight loss stance in 2012 - ANS--added "evaluate body weight gain - body weight loss no more than 7% from birth and no further weight loss by day five: assess feeding and consider more frequent follow-up" Adult GI hormones - ANS--also impacted by suckling When mother suckles her gastrin and cholecystokinin go up. This increases the efficacy of insulin and increases the storage of ingested nutrients After 1 year of lactation - ANS--has significantly increased fat and energy contents Anatomy of human breast - ANS--glandular tissue made up of clusters of alveoli and small ducts, fat amongst the glandular tissue, milk ducts, areola, nipple with several duct openings Anatomy of milk cells - ANS--myoepithelial cells, connective tissue, capillaries, anteriole, venule, alveolar cells Babyled feeding - ANS--"the breast-fed baby can regulate his fat intake quickly and thus mothers should be encouraged to practice baby-led feeding" Breast feeding: a public health priority - ANS--has been recognized as a public health priority in tropical climates since the 1930's, but not until the 1990's in the US Breastfeeding associated hypernatremia - ANS--hypernatremia is a common complication of inadequate milk transfer during breastfeeding - completely preventable complication that seems to be relatively common Breastfeeding promotion - ANS--focuses on advantages of breastfeeding on a personal, community, country, or global level Breastfeeding support - ANS--focuses on the interaction of "helpers" with family as well as program development and implementation Carry, follow, or hibernate - ANS--mammal species with hither water content milk have more frequent feeds Carry = koala Follow = elephants Hibernate = bears CLC - ANS--nationally recognized designation awarded by the ALPP to those who are exam eligible and pass the exam; have competenct verified Clcs and ibclcs - ANS--health professionals who provide lactation support Community expertise - ANS--variety of community expertise is needed to promote, protect, and support breastfeeding Cooper findings re: weight loss findings - ANS--- babies were not identified before 10% weight loss - a "contented" (sleepy) baby is NOT a well-fed baby (calorically deprived babies are sleepy) Costs to prevent needless deaths - ANS--less than $6 billion/year worldwide Diarrhea mechanisms 1 - ph of the gut - ANS--breastfed babies' gut is more acidic while formula-fed babies' guts are more neutral/basic Gut bacterial colonies (the microbiome) of mixed fed babies are similar to exclusively formula fed babies Diarrhea mechanisms 2 - low iron in the gut - ANS--relatively low iron content in human milk Diarrhea mechanisms 3 - presence of bifidus factor - ANS--promotes intestinal presence of lactobacillus bifidus that maintain the low ph and crowd out pathogenic organisms Diarrhea mechanisms 4 - presence of hormones - ANS--hormone like factors and growth factors that stimulate growth and development of the GI tract and GI motility, such as: - GI hormones - prolactin - EGF (epidermal growth factor) - prostaglandins Diarrhea mechanisms 5 - antibodies - ANS--such as siga bind to microbes in the baby's intestinal tract and prevent them from being absorbed into the rest of the body. Mother's iga has been found to protect against the development of NEC in preterm infants. Maternal iga shapes the host-microbiota relationship of pretern neonates that iga in maternal milk is critical and necessary factor for the prevention of NEC Diarrhea mechanisms 6 - white blood cells - ANS--kill microbes directly or mobilize other defenses Diarrhea mechanisms 7 - cell wall disrupters - ANS--kill microbes by destroying the cell walls, these include fatty acids and lysozymes Diarrhea mechanisms 8 - B12 binding factor - ANS--reduces the amount of B12 in the intestines available to microbes Diarrhea mechanisms 9 - lactoferrin - ANS--deprives bacteria of iron, disrupts the integrity of the outer membrane of bacteria, assists in intestinal maturation and in the recovery of the intestine from injury and other mechanisms Diarrhea mechanisms 10 - antimicrobial activity boosters - ANS--such as fibronectin and gamma interferon Diarrhea mechanisms 11 - mucosal wall protectors - ANS--such as mucins and oligosaccharides, which also function as food for beneficial bacteria, adhere to microbes binding them so that they can't attach to the gut wall Diarrhea mechanisms 12 - microbes - ANS--from the mothers skin and bacteria in the mother's breastmilk seed, the infant gut underscoring Diarrhea mechanisms 13 - contaminants - ANS--absence of contaminants (bottles, teats, water) and formula ingredients Diarrhea mechanisms 14 - antibodies - ANS--a. When a mother is exposed to organisms she makes antibodies and secretes them into her milk B. Another way baby is protected - cells go from the baby's mouth into the breast and antibodies are made in the breast The process of breastfeeding has effects beyond the components of the milk. Breastfeeding changes both i'mmune system Disparity of US breastfeeding trends - ANS--according to the CDC, "black mothers are less likely than white to breast-feed their babies, and here's one possible reason why: hospitals in neighborhoods with many black residents do less to promote nursing than those in areas with more white residents" End - ANS--1B Fore vs hind milk - ANS--foremilk is milk at the beginning of a feed, hindmilk is at the end of a feed - used to think that hindmilk contained more fat content but it is more complex than originally described - foremilk does not mean "low fat" and hindmilk is not always highest in fat - sometimes foremilk and hindmilk have equal amounts of fat and we should not give mothers tules based on the ideas of fore and hindmilk Gastrointestinal hormones - gastrin, chloecystokinin - ANS--promote induced insulin release and growth promoting effects in the gut Gastrointestinal hormones - somatastin - ANS--inhibits GI secretion, inhibits motility in the GI tract and the release of most GI hormones. Inhibits the secretion of HGH from the pituitary and inhibits cellular growth and proliferation In the gut Hormone pathways - ANS--two separate hormone pathways, pituitary gland is important to both Hormones of lactation - ANS--have an emotional/behavioral function as well as making and moving milk; aggression, protection, bonding & trust How do we assure an adequate milk supply? - ANS--- universal understanding of how breastfeeding works - early initiation and adequate breastfeeding (10-12x/daily) - appropriate breastfeeding assessment - improved and early breastfeeding support to decrease "lactastrophes" - appropriate HCP and LCP follow-up in the postpartum (see reasons to refer) - admitting theres no magic bullet How do you know about breastfeeding adequacy? - ANS--fewer than 4 soiled diapers on day 4 when used in conjunction with delayed onset of lactation may indicate breastfeeding inadequacy - four on four... And each day after How has the AAP responded to hypernatremia? - ANS--- ensure formal evaluation and documentation of breastfeeding by trained caregivers (including position, latch, milk transfer, examination) at least for each nursing shift - all breastfeeding newborn infants should be seen by a pediatrician at 3-5 days of age, which is within 48-72 hours after discharge from hospital - evaluate: hydration (elimination patterns), body weight gain (body weight loss no more than 7% from birth and no further weight loss by day 5), discuss maternal/infant issues - observe feeding How is it possible for humans to make milk with such a small amount of energy expenditure? - ANS--- maternal plasma prolactin concentration generally increases under conditions of negative energy balance, which may serve to protect lactation - changes in maternal processes can spare energy.. This may account for a third to half of the total costs of milk synthesis - together with the low cost of human lactation and large fat reserves from pregnancy, may account for human ability to breastfeed our infants under nutritional conditions which are often far from ideal How to support ebf - ANS--increase hospital and health system capacity regarding baby friendly hospital initiative -provide community based strategies including campaigns tailored to local context -strengthen monitoring and enforcement of the code -enact at least 6 months paid maternity leave -invest in training and capacity building in protection, promotion, support Hypernatremia frequency of feeds difference - ANS--10.2 for healthy infants vs. 7.6 in the NHD admitted infants Hypernatremia weight loss difference - ANS--1.6% in healthy infants vs. 16.2% in hypernatremic addmited infants Infants lose more weight in the first postpartum days... - ANS--- when labor meds are used... But perhaps not at a baby-friendly hospital - when more intrapartum fluids have been given - when there was no labor prior to cesarean However, supplementation rates for weight loss decreased with routine use of 24 hr weight and did not increase untoward effects during the hospital stay Infrequent nursing - ANS--leads to lower levels and less rise even with the same amount of nipple contact Initiation for mothers of preemies - ANS--initiation of milk expression before one hour resulted in significantly more milk when measured on days 7 and 42 International code of matketing of breastmilk substitutes (the code) - ANS--an international health policy framework to regulate the marketing of breastmilk substitutes in order to protect breastfeeding - published by the WHO in 1981 - internationally agreed voluntary code of practice - written in response to the marketing activities of the infant feeding indurstry which were promoting formula feeding over breastfeeding, which in turn was leading to dramatic increases in maternal and infant morbidity and mortality - subsequent clarifying and extending resolutions have been passed by the world health assembly International models - ANS--for integrating breastfeeding promotion, protection, and support as well as balancing technical information, programs, and protocols Lack of timely interventions - ANS--mother's problems at 3 to 7 days posed as the greatest risk to stopping Lactogenesis I - ANS--secretory differentiation, placental hormones, colostrum Lactogenesis II - ANS--secretory activation, after complete delivery of placenta, rapid drop in progesterone, transitional milk Lactogenesis III - ANS--lactation, galactopoesis, prolactin from frequent nipple stimulation, frequent removal of milk, mature milk Less diarrhea - ANS--most readily acknowledged advantage od breastfeeding, ebf makes the biggest difference in rates and severity - 86% of diarrhea-associated infant deaths occurred among LBW infants - if breastfed baby does get diarrhea, keeping breastfeeding makes a difference in maintaining the microbiota Making milk - ANS--messages from the breast travel through the nervous system to the brain, then hormones travel to the breast through the blood system Maternal stress - ANS--breastfeeding mothers may perceive less stress Compared to formula fed mothers, breastfeeding mothers: - had more positive moods - reported more positive events - perceived less stress Maximum fat levels - ANS--obtained 30 mins post-feed - mothers of male infants seem to produce milk that has 25% greater energy content than mothers of female infants Mechanisms by which ebf protects from diarrhea - ANS--1. Ph of gut 2. Low iron in gut 3. Presence of bifidus factor 4. Presence of hormones 5. Antibodies such as siga 6. White blood cells 7. Cell wall disrupters 8. B12 binding factor 9. Lactoferrin 10. Antimicrobial activity boosters 11. Mucosal wall protectors 12. Microbes 13. Absence of exposure to contaminants 14. Antibodies 15. Synergistic effect Milk composition - ANS--is complex - each species of mammal milk is different - milk is "species specific" Milk composition, milk action - ANS--milk composition is complex, milk action is redundant - milk is more than nutrition, bioavailability of nutrients is higher in human milk than in other foods or supplements MYTH - exercising or working too hard impacts supply - ANS--maternal exercise when breastfeeding was not related to changes in macronutrients or volume or infant weight gain or growth. Rest is not associated with increased milk production. MYTH - its about the types or amounts of foods eaten during laction - ANS--humans have breastfed and are breastfeeding under conditions we can't even imagine. This is possible because: - lactation has a lower energy cost for humans compared to other mammals - number of kcal/day for lactation is much less than previously believed - the body adapts with physiological mechanisms in favor of lactation in humans MYTH - not getting enough fluids impacts volume of milk - ANS--there is not enough evidence to support increasing fluid intake beyond with breastfeeding mothers are likely to require to meet their physiologic needs MYTH - not getting enough rest - ANS--"fatigue" may be tiredness, but also may be a symptom of an underlying medical problem that could affect milk supply. MYTH - size of the breast relates to the amount of milk - ANS--the proportion of glandular and fat tissue and the number and size of the ducts are not related to milk production. For health providers, perceptions of who will have difficulty with breastfeeding may be related to breast size. MYTH? Worry/stress?? - ANS--increased worry/stress does not seem to directly diminish milk supply in humans, however... - worry/stress may alter behavior, which may alter supply Nest or cache - ANS--mammal species with high fat/protein and low water content = infrequent feeds Nest = bunnies Cache = deer Nursing a baby for a year or more - ANS--decreases by 10-15% the risk of developing hypertension, diabetes, hyperlipidemia, and cardiovascular disease Nursing pattern - ANS--should be frequent to accommodate human milk composition Ongoing milk production - ANS--positively associated with suckling within the first 2 hours after birth Our culture - ANS--wants us to be nesters when it comes to feeding, but our milk composition indicates that we should be carriers Postpartum post traumatic stress disorder (PP-PTSD) - ANS--up to 9% of PP women met the DSM-5 criteria for PTSD after childbirth Pregnancy & breastfeeding in re: to T2DM - ANS--pregnancy itself may bring an increased risk for Type 2 diabetes in the mother, which breastfeeding can negate. Compared with women who have not had children, childbearing women who do not breastfeed have a 50% increased risk of T2DM in later life Preterm milk - ANS--appears to have a different composition for the first 5-7 weeks after delivery independent of gestational age at delivery - appears to be higher in protein, fat, and electrolytes than term milk - if baby is SGA, LGA, or AGA, does not make a difference in milk composition Prolactin levels - ANS--go down in between nursing and rise during nursing Restricting marketing - ANS--does not mean that the products cannot be made available, neither does it restrict parents choice; it simply aims to make sure that their choices are made based on full, impartial information, rather than misleading, inaccurate, or biased marketing claims Stages of making human milk - ANS--lactogenesis I, lactogenesis II, lactogenesis III Stress & hormones - ANS--stress + male hormones = fight or flight Stress + oxytocin + female hormones = tend and befriend Suboptimal breastfeeding - ANS--accounts for more than 3,340 maternal and child deaths a year, 80% are maternal The brain - ANS--most rapidly developing organ in human newborns; human milk is the ideal fuel for brain growth The code - ANS--regulates the marketing of breastmilk substitutes which includes infant formulas, follow-on formulas, and any other food or drink, together with feeding bottles and teats, intended for babies and young children; sets standards for the labeling and quality of products and for how the law should be implemented and monitored within countries The strategy - ANS--is intended as a guide for action - it identifies interventions with a proven positive impact - it emphasizes providing mothers and families the support they need to carry out their crucial roles - it explicitly defines the obligations and responsibilities in this regard of governments, international organizations, and other concerned parties The world breastfeeding trends initiative - ANS--intended to track, assess, and monitor the implementation of the "global strategy" at the country and sub-country level Triggering oxytocin mechanism #1 - ANS--conditioned response - conditioned milk ejection (let down) reflex - was probably given too much importance in the years we didn't understand the other mechanisms - conditioned over time and lasts a lifetime - is faster for women who already have one from previous breastfeeding - to condition response.. Smell, touch, hear the stimulus Triggering oxytocin mechanism #2 - ANS--nipple stretching, happens with a proper latch Triggering oxytocin mechanism #3 - ANS--baby hand massage, each hand movement releases oxytocin Two conditions that increase odds of PP-PTSD - ANS--- depressive symptom scores - total number of physical symptoms experienced since birth Unrealistic expectations - ANS--lack of preparation for what the newborn period would look like Weight loss in the BF neonate - ANS--in first date after birth, most babies lose weight, some from normal diureses What contributes to low rates of ebf globally? - ANS--- caregiver and societal beliefs favoring mixed feeding -hospital and healthcare practices and policies that are not supportive of BF - lack of adequate skills and support - aggressive promotion of infant formula and other breastmilk substitutes - inadequate maternity/paternity leave legislation - workplace policies - lack of knowledge about dangers of not exclusively BF and proper BF techniques What do we know about breastfed babies who become dangerously undernourished? - ANS--report by cooper & colleagues identified a significant increase in the incidence of malnutrition and hypernatremia in breastfed infants - 5 sentinel cases in ohio began a chart review of the prior 4 years - chart review babes were 23% below birth weight on average on readmission and showed clinical signs of dehydration and hypernatremia - babies were: not d/c early, nursing q 3-4 or 4-6 hrs, scheduled, both breasts, 5-10. Min a side, SLEEPY - researchers found: the class was inadequate, inadequate follow up in the community post-partum What increases gastrin and decreases somatostatin in babies? - ANS--- sucking babies have cutaneous (touch) receptors in their mouths that respond to sucking starting at 27 weeks gestation - species own milk - decreased stress - touch - wellness When the infant suckles from the breast... - ANS--there is an outpouring of 19 different GI hormones in both the mother and the infant, including cholecystokinin, which cycles to the kidneys, and gastrin, which stimulates growth of the baby and mother's villi, increasing surface area and absorption of calories with each feeding WHO and UNICEF three strategies - ANS--for increased breastfeeding initiation and duration in every country: promotion, protection, and support Why is breastfeeding so difficult? - ANS--1. Unrealistic expectations 2. Lack of timely interventions Women who do not breastfeed - ANS--are at greater risk for myocardial infarction and aspects of metabolic syndrome; are at a greater risk of breast, endometrial, and ovarian cancer